UTERINE FIBROIDS (MYOMAS)

These knobs of muscle tissue grow from the lining of the uterus into its interior, from the outer surface of the uterus, or they may be buried in the myometrium, the muscular wall of the uterus. They vary from the size of pumpkin seeds to oranges, although they can become even bigger, and usually grow slowly. They can cause excessive bleeding, pelvic pain, back pain and symptoms related to the pressure they exert on nearby organs, such as the bladder, bowel or rectum. Fibroid complications include urinary frequency (if fibroids are exerting significant pressure on the bladder), haemorrhoids or varicose veins in the legs (when the rectal or pelvic veins are squashed), and constipation (when the pressure is to the bowel).

Fibroids do not spread outside the uterus and are not a form of cancer. On very rare occasions a fibroid develops into a sarcoma, which is a cancer capable of spreading into various parts of the body. If fibroid growth is exceptionally rapid, a sarcoma may be suspected. Fibroids normally shrink after menopause. This post-menopausal decline in size is an important phenomenon because it means that ‘toughing out’ fibroid problems until menopause provides a solution for some women.

Although widely referred to as fibroids, doctors may also describe these growths as uterine fibroid tumours, uterine leiomyomas, fibroid polyps, fibromas, myomas, fibroleiomyomas or fibromyomas. It has been estimated that around 20% of women over the age of thirty have one or more fibroids in their uterus; but in many cases these do not cause problems and are never discovered. Suspicion about the presence of a fibroid or fibroids in other women may, however, arise if the uterus is inexplicably enlarged or if menstrual periods become consistently heavier than in earlier years.

For about a third of women with fibroids the amount of blood lost during menstruation is a problem that may be accompanied by anaemia. This means there are fewer than normal red blood cells in the bloodstream, leading to a low haemoglobin level and associated fatigue, weakness and, in very severe cases, heart palpitations or heart pain (angina). Even when fibroids are small they can lead to problems of heavy bleeding, pelvic pain, back pain and urinary frequency. The reasons why fibroids sometimes cause pelvic pain are uncertain but may include the twisting of the fibroid back on itself, degenerative changes to or infection of the fibroid, or the growth of a large fibroid which the uterus tries to push out, especially during menstruation.

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